The Africa Centre for Health and Population Studies.
Photograph: Wellcome Trust

The Africa Centre for Health and Population Studies sits in the HIV capital of the world. The sleek modern building, rising out of an otherwise rustic setting near Mtubatuba in South Africa, attracts world-class researchers looking to wage war against the resilient virus.

“It’s the frontline,” says Deenan Pillay, the centre’s director, on secondment as professor of virology at University College London. “We’re in one of the highest-incidence HIV areas in the world and it is essential to understand how to reduce new cases. I’m very privileged to be working with this population and it’s a place where I think research can very clearly be seen to be making a difference.”

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The centre opened in 1998 and receives £3.5m to £4m a year from the Wellcome Trust, along with more than double that amount from external funders including French and American health agencies, the EU, the South African Medical Research Council and the Bill & Melinda Gates Foundation. The list of papers published by the centre’s researchers in scientific journals numbers 99 last year alone.

Currently part-hidden by scaffolding as it undergoes renovations to expand its operations, the Africa Centre lies deep in rural KwaZulu-Natal province, close to a wildlife park where elephants and rhinos roam. Many local people are subsistence farmers living in traditional thatched-roof rondavels and keeping chickens and goats. Rates of tuberculosis among the local population are extraordinarily high.

Reducing HIV, TB and other associated diseases is at the heart of the Africa Centre’s work, according to Pillay, but the benefits go far beyond South Africa. “The research that we do there is highly relevant to other similar poor areas of the world in terms of how to counteract HIV.”

All studies must be approved by an elected community advisory board. Pillay, who has been in the post for 18 months, adds: “To work in the community and do household surveillance, in other words knocking on people’s metaphorical doors three times a year, you have to have a very strong community engagement.”

For 12 years the centre has carried out household surveillance of 100,000 individuals to understand their lifestyles and environmental conditions. It marries this with data from the district hospital in nearby Hlabisa and 17 associated primary care clinics.

“We can relate what people’s lives are in their homes to then what happens when they get to a clinic and whether they take treatment and respond properly. The goal of that research is to develop strategies that can prevent HIV better, but also treat HIV better and ensure the health service has capacity to do that.”

Under way now is a very large cluster of randomised trials involving 25,000 people, to investigate whether testing people for HIV and treating them immediately, irrespective of the health of their immune system, will reduce the number of new infections. It is funded by France’s National Agency for Aids Research and the Gates Foundation.

Pillay explains: “It’s asking the question, if you treated everyone with HIV in a population, would that reduce the number of people newly infected compared to what currently happens, where treatment is not given to everyone with HIV but it’s given to people with HIV whose immune systems are partially damaged, defined by a marker in the blood? These are WHO [World Health Organisation] guidelines that the South African government adheres to.”

The centre is also a source of advice and expertise for the South African government which – the bleak years of “Aids denialism” now well behind it – is coordinating the biggest HIV treatment programme in the world. It offers educational programmes and seminars for local doctors and nurses and is an attractive draw for professionals who might otherwise be reluctant to move to such a remote rural area.

Pillay adds: “We don’t provide clinical services per se but we have doctors and nurses working at the Africa Centre who do research in those clinics in partnership with the Department of Health. There’s a fine line between whether we actually do clinical work, but of course we do have doctors coming to the Africa Centre who want to do research and in that process also support the Department of Health in provision of health.”

The Africa Centre currently employs about 400 people, mostly field workers and data managers. Fifteen nationalities are represented but the clear majority are drawn from the local community, making it one of the biggest sources of work – and providers of training – in an area where the unemployment rate stands at around 70%.

For Pillay, 57, born in London to South African parents who took up the struggle against racial apartheid, it is a personal calling. “My research interest is in how HIV becomes resistant to the drugs used against it. After many years in that area, I thought that the place where I can really have my research have most impact is this sort of setting, so that’s what brings me here.”